Department of Radiology, the Third Hospital, Hebei Medical University, Shijiazhuang, China.
Sci Rep. 2020 Mar 4;10(1):4001. doi: 10.1038/s41598-020-60725-9.
To investigate the characteristics of imaging changes with time of facial fractures, patients with facial fractures who had computed tomographic scan were enrolled including 500 patients who were divided into six groups based on the time of scanning: super early (<3 d), early (4-7 d), early-to-medium (8-14 d), medium (15-21d), medium-to-late (22d-2 months) and late stage (>2 months). The data were compared and analyzed. Forty two patients with frontal bone fractures had high-energy impact as the reason of fractures. The fracture line was clear and sharp within one week but blunt and sclerotic due to bone absorption at 2-3 weeks, and might exist for a long time. All patients had soft tissue swelling and paranasal sinus effusion at 1-2 weeks after injury. Air might gather in the adjacent soft tissues and/or intracranially within 3 days of injury if the fracture involved the frontal or other sinuses. Twelve of the 42 patients (28.6%) had intracranial hematoma, and five (11.9%) had epidural effusion. Subarachnoid hemorrhage was mostly absorbed within one week while epidural hematoma was completely absorbed over 3 weeks. Significant changes (P < 0.05) in the fracture lines, effusion of paranasal sinuses, soft tissue swelling and pneumocephalus were observed during the study period. For patients with medial orbital wall fractures, the fracture line was sharp and clear at early stages with concurrent sphenoid sinus effusion, and the fracture line became depressed 3 weeks later with disappearance of sphenoid sinus effusion. Significant changes (P < 0.05) were observed in the sharp fracture line, soft tissue swelling, sphenoid sinus effusion and smooth depression at fracture sites. For nasal fractures, the fracture line was sharp and clear at early stages with concurrent soft tissue swelling which disappeared one week later. The fracture line became smooth three weeks later. A significant (P < 0.05) difference was demonstrated in the changes of fracture line and soft tissue swelling with time. In conclusion, facial fractures have some dynamic alterations with time and identification of these characteristics may help reaching a correct clinical diagnosis with regard to fracture severity and time.
为了研究面部骨折影像学变化的特点，对行 CT 扫描的面部骨折患者进行了研究，共纳入 500 例患者，根据扫描时间将其分为 6 组：超早期（＜3d）、早期（4-7d）、早中期（8-14d）、中期（15-21d）、中晚期（22d-2 个月）和晚期（＞2 个月）。比较并分析了这些数据。42 例额骨骨折患者因高能量撞击而致骨折，骨折线在 1 周内清晰锐利，但在 2-3 周时由于骨吸收而变得钝而硬化，可能长期存在。所有患者在受伤后 1-2 周均有软组织肿胀和鼻旁窦积液。如果骨折累及额窦或其他窦，则在受伤后 3 天内，骨折周围的软组织和/或颅内可能会积聚空气。42 例患者中 12 例（28.6%）有颅内血肿，5 例（11.9%）有硬膜外积液。蛛网膜下腔出血在 1 周内基本吸收，硬膜外血肿在 3 周内完全吸收。研究期间观察到骨折线、鼻旁窦积液、软组织肿胀和气颅均有明显变化（P＜0.05）。对于内侧眶壁骨折患者，骨折线在早期阶段清晰锐利，同时伴有蝶窦积液，3 周后骨折线凹陷，蝶窦积液消失。在锐利骨折线、软组织肿胀、蝶窦积液和骨折部位平滑凹陷方面观察到明显变化（P＜0.05）。对于鼻骨骨折，骨折线在早期阶段清晰锐利，同时伴有软组织肿胀，1 周后肿胀消失，3 周后骨折线变平滑。骨折线和软组织肿胀随时间的变化有显著差异（P＜0.05）。总之，面部骨折随时间存在一些动态变化，识别这些特征有助于正确判断骨折的严重程度和时间。
